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HomeMy WebLinkAboutMIS94-0252 Cancelled Foundation - MIS Permit / Conditions - 11/2/1994 MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O, Box 186 Shelton, Washington 98584 f—, I I A 9%1 IC) t P F> M X -V 0 1 J0f;I 11AR"C' 27S-286`0 sit !!fi I AOUA AORW+ '.�76 1. I ( ;'A) still$ (4vt Div 3 It 44 fs #4131 01 W- FOUNDAI ION ONLY R18(iONS ANO J IF IIOWN*,, ON MAIN ROAD , ON CLF T SIDE N 11 Y I It j f r # II t' �Y.r. CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date( �7 Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final ,�,� ` date by date by date v�� S—Ze)—$ y cam✓ FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by docivt S D.W.V. WALLBOARD NAILING C 2- date by date by Water Line FINAL INSPECTION date by date by date by • Permit No. �� q MASON COUNTY BUILDING PERMIT APPLICATIONs �°y 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 Owner c ( O 1- Phone# ��� Site Address .141 tin M Fire District# City V, St Zip Directions to Job Site a C` Owner Mailing Address _� © 12,06 City StZi 995�za� Lien/Title Holder Address r e e City St Zip #2 Contractor Name���� r4J V C'bte 1,P1 9 _ Contractor Reg#44yn Address (, 1� i/ee 1A 2. Expiration Date City & G M e e'er vi St Lok Zip Phone# #3 If septic is located on project site, include records. Connect to Septic? VeS Public Water Supply VWell Connect to Sewer ystem? --Z,10 Name of S tem ? (If residential, proof of potable water is required) #4 Parcel No. O - 5 0_- 000 Legal Description ) 0 f J S e < a e'"Ot S (�A d #5 Building Square Footage: (existing/proposed) 1st FI / 2nd FI / 3rd FI / Loft / Basement / Deck #bedrooms #bathrooms / Garage / / (Circle:Attached or Detached?) Other ft. / #6 Use of building G Describe work I #7 Type of Job: New Add Alt Repair Other�� #8 ILE NUFACTURED HOME INFOOfjM�1T�iON Model Year�B Make w�5� Mod`el �0 c,J Length_Width X% Serial No. # Bedrooms 3 # Bathrooms_Type of Heat Purchase Price #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other At//A Show following on the site plan _ J Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells C� Proposed Improvements Easements Indicate Directions by (N, S, E, W) Name of Flanking Street Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW ® n 1 -FOY -�ACLA c-c APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW V PIW mbing Fixtures ($3 each) F Mechanical Fixtures ($6 each) No._Toilets CIRCLE FUEL TYPE: Gas, Electric, ath Basins Heatpump, Other B h Tubs No. UnitsFees Sho ers Furn BTU _Hot ter Htr _ Heatpumps _Laundry Wash r Vent Systems _Sinks Spot Vent Fans Floor Drain No. Boilers/Cc m re or _Laundry B sin _ HP Dishwas er No. Air H ndlin Znits _Dispos I c m# _Urinal No. Fir Prote ion Systems _Othe Auto. it Alarm Sys 50.00 �-�-� Fixed F' Supp. Sys 50.00 Permit asic Fee 15 ae- _ Auto F' e Sp ink Sys 25.00 TOTAL PLUMBING $ No. Other Gas utlets Wo d, Gas, Pellet tove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Perm asic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $ MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT X OWNER X BY DATE DATE FOR OFFICIAL USE ONLY: Accepted by: Date: 0(qq VOL DEPARTMENTAL REVIEW f FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review 47 e— c&,�(,XS Q1(k eQ Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit r5m�� c� Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other Other } �> Building Valuation: TOTAL FEE L